Wednesday, May 21, 2014

Pragmatic Complementary Therapy for Breast Cancer

     In examining the complementary therapy of exercise for breast cancer patients I was struck by a pressing question concerning the pragmatism of this therapy in comparison to what is currently available. Especially, since the incidence of breast cancer is continuing to increase and in 2008 alone it affected 1 million women globally. It is worth considering exercise as a complementary therapy that may be a more cost effective means in providing treatment for breast cancer patients.
Breast Cancer is a global disease and comprehending the differences in cost of standard of care are germane to the issue of pragmatic interventions. It becomes increasingly apparent that economic factors are at the center of the issue of care. Currently, the mortality is greatest in developing countries and highest in the regions of Africa, Latin America and the Caribbean. This map below provides a visual context for this phenomena:

  Some possible explanations abound for this phenomena such as genetics, availability of screening, and care. However, the most common denominator appears to be driven by the prevailing theme that economics is a determinate to treatment.
  A review article entitled, " Costs and Health Effects of Breast Cancer Interventions in Epidemiologically Different Regions of Africa, North America, and Asia" addresses the disparities in cost of treatment and examines this phenomena in terms of DALYs. DALYs is short for disability-adjusted life year. It is a measure of difference between the present health status and ideal health. An examination of this table below allows for several key conclusions to be formulated.

   One of the notable conclusions is patients in North America are treated significantly earlier than patients in Africa. This may be explained by the fact that Africa has significantly less access to screening. A glance at the amount spent on screening over the past 10 years shows a significant discrepancy in cost compared to North America and Asia.  Further, evaluation of the data illustrates that North Amercian and Asia are equivalent in the ability to prevent the burden of this disease. However, per patient Africa has a higher averted DALY per patient. Possibly, this result is due to the various sample size differences over the past 10 year period. Moreover, it is important to note that the population of breast cancer patients in North America was about 33% larger than the other regions. In comparison Asia and Africa had an equivalent number of breast cancer patients. A compelling piece of evidence to the disparity in treatment and economic resources is illustrated in the total cost spent on treatment for stage I breast cancer. North America's medical expenditures were 57 times greater than what Africa spent and 27 times more than what Asia spent on the total cost of treatment for stage I breast cancer. It should be noted based on CER (cost effectiveness ratio) that treatment is only cost effective during the earliest stages of the disease. This implies that more cost effective treatments are required to deal with the economic demands of the disease.
     This data particularly illustrates the disparities in treatment based on the WHO regions. Apparently intervention is costly and developing nations are unable to pay for the treatment required to alleviate the burden of cancer. These unsettling conclusions could suggest that aerobic exercise such as walking might be a cost effective complementary therapy. This therapy could be easily implemented even by a region lacking in economic resources.  According to the results of our study exercise increases survival outcome by 60% in stage 0-IIIA breast cancer. Exercise is a successful means to regulate epigenetic factors that have positive outcomes on survival. Furthermore, exercise has effects that are capable of adjusting hypermethylation and hypomethylation of genes. This could circumvent some of the current problems with cancer therapy such as the inability to adapt to the changes cancer causes. Exercise could circumvent some of these problems by epigenetically regulating favorable changes. It may even prove helpful to alleviate the side effect of  the drugs such as trastuzumab that can cause heart problems.
    Finally, it is apparent why the NCCN highly recommends that exercise could be an effective complementary therapy. Exercise could be implemented with minimal cost as a treatment therefore, making the therapy available to patients from any region. It would be advantageous to implement such a cost effective therapy for social justice reasons and to circumvent the burden of cancer.


Coughlin, Steven S., Donatus U. Ekwueme. "Breast Cancer as a global health concern". The International Journal of Cancer Epidemiology, Detection, and Prevention. 33 (2009) 315-318.

Corliss, Julie. "Exercise: Powering up". Nature. 485 (2012) 62-63.

 Ferlay J, HR Shin, Bray F, Forman D, Mathers C and Parkin DM."Cancer's Global Foot Print Interactive Map of Cancer". Globocan. Interanational Agency for Research on Cancer. 2010. Web May 19, 2014.

Groot T. Martijin, MSc, Rob Baltussen, PHD, etc al. "Costs and Health Effects of Breast Cancer Intervetions in Epidemiologically Different Regions of Africa, North America, and Asia".Global Epidemiologic Methods.2006.Web. May 2014.

"National Comprehensive Cancer Network."NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, 2014 Web. 21 May 2014.

Stathopoulos-Ntanasis J., J-G. Tzanninis, A Philippous, M. Koutsilieris. "Epigenetic Regulation on gene expression induced by physical exercise". Journal of Musculoskelet Neuronal Interact 2013; 13(2): 133-146.

Zeng, Hongmei, Melinda L. Irwin, Lingeng Lu, Harvey Risch, Susan Matne, Liama Mu, Qian Feng, Luca Scarampi, Marco Mitidieri, Dionyssios Katsaros, Herbert Yu. "Physical activity and breast cancer survival: an epigenetic link through reduced methylation of a tumor suppressor gene L3MBTL1." Breast Cancer Research treatment (2012) 133: 127-135 Web. Apr 2014.